A New Recalibrated Four-Category Child-Pugh Score Performs Better than the Original Child-Pugh and MELD Scores in Predicting In-Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real-World Cohort Analysis.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
pubmed:
5
10
2019
medline:
29
10
2020
entrez:
5
10
2019
Statut:
ppublish
Résumé
There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child-Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child-Pugh (rCP). This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves. During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50-0.670) and MELD (AUROC 0.62, 95% CI 0.51-0.73) to predict rebleeding (p = 0.72), or between the Child-Pugh (AUROC 0.75, 95% CI 0.71-0.81) and MELD (AUROC 0.71, 95% CI 0.62-0.80) to predict death (p = 0.35). The rCP classification (A-D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77-0.89) compared to the CP score (A-C) and MELD to predict death (p = 0.004). A recalibrated Child-Pugh score outperforms the original Child-Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.
Sections du résumé
BACKGROUND
There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child-Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child-Pugh (rCP).
METHODS
This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves.
RESULTS
During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50-0.670) and MELD (AUROC 0.62, 95% CI 0.51-0.73) to predict rebleeding (p = 0.72), or between the Child-Pugh (AUROC 0.75, 95% CI 0.71-0.81) and MELD (AUROC 0.71, 95% CI 0.62-0.80) to predict death (p = 0.35). The rCP classification (A-D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77-0.89) compared to the CP score (A-C) and MELD to predict death (p = 0.004).
CONCLUSION
A recalibrated Child-Pugh score outperforms the original Child-Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.
Identifiants
pubmed: 31583458
doi: 10.1007/s00268-019-05211-8
pii: 10.1007/s00268-019-05211-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
241-246Références
Dig Liver Dis. 2006 Dec;38(12):899-904
pubmed: 17005458
J Hepatol. 2004 Aug;41(2):344-50
pubmed: 15288486
Ann Surg. 2006 Nov;244(5):764-70
pubmed: 17060770
Am J Gastroenterol. 2003 Mar;98(3):653-9
pubmed: 12650802
Hepatology. 2004 Sep;40(3):652-9
pubmed: 15349904
Endoscopy. 2007 May;39(5):478; author reply 478
pubmed: 17516360
Hepatology. 2003 Sep;38(3):599-612
pubmed: 12939586
Dis Markers. 2011;31(3):155-64
pubmed: 22045401
Ann Gastroenterol. 2018 Jan-Feb;31(1):84-89
pubmed: 29333071
Gastroenterology. 2014 Feb;146(2):412-19.e3
pubmed: 24148622
Am J Gastroenterol. 2011 Oct;106(10):1787-95
pubmed: 21625271
J Clin Gastroenterol. 2017 May/Jun;51(5):446-453
pubmed: 27779613
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1347-54
pubmed: 19699816
Hepatol Int. 2018 Feb;12(Suppl 1):81-90
pubmed: 28634688
World J Hepatol. 2010 Jul 27;2(7):261-74
pubmed: 21161008
Hepatology. 2000 Apr;31(4):864-71
pubmed: 10733541
Br J Surg. 1973 Aug;60(8):646-9
pubmed: 4541913
Dig Dis Sci. 2016 Nov;61(11):3309-3320
pubmed: 27405990
Dig Dis Sci. 2011 Apr;56(4):977-87
pubmed: 20844956
N Engl J Med. 2010 Mar 4;362(9):823-32
pubmed: 20200386
Am J Gastroenterol. 2012 Dec;107(12):1872-8
pubmed: 23007003
J Hepatol. 2015 Sep;63(3):743-52
pubmed: 26047908